NIHSS Facial Palsy 5 — Questions and Answers
Question 1: A nurse re-evaluates a stroke patient 6 hours after admission and notes the patient can raise both eyebrows but cannot move the left lower face at all. She scores Facial Palsy as 2. Is this correct?
- No – complete lower facial paralysis with intact upper face should be scored 3
- Yes – total lower facial paralysis with spared upper face is score 2 (Correct answer)
- No – any facial asymmetry that involves total lower-face paralysis is scored 1
- Yes – bilateral findings always score 2
Correct answer: Yes – total lower facial paralysis with spared upper face is score 2
Score 2 correctly captures total or near-total lower facial paresis with the upper face spared, which is the definition of partial (central) palsy.
Question 2: The NIHSS Facial Palsy item assesses:
- Sensory loss over the cheek and chin
- Voluntary and reflex motor function of facial muscles (Correct answer)
- Coordination of tongue and lip movements for speech
- Jaw strength and bite force
Correct answer: Voluntary and reflex motor function of facial muscles
The item tests voluntary facial movement (e.g., show teeth) and, in unresponsive patients, reflex grimacing to noxious stimulation.
Question 3: A patient presents with isolated right-sided facial droop after stroke. The clinician tests facial symmetry. Which of the following findings would be scored as NIHSS Facial Palsy = 1?
- Absent right lower facial movement; eye closure intact
- Slight flattening of the right nasolabial fold with a mildly asymmetric smile (Correct answer)
- Complete right-sided paralysis of upper and lower face
- Symmetric facial movement with no detectable asymmetry
Correct answer: Slight flattening of the right nasolabial fold with a mildly asymmetric smile
A slight nasolabial fold asymmetry or mildly asymmetric smile without functional lower facial paresis constitutes minor paralysis, scored 1.
Question 4: During a stroke code, the NIHSS examiner notices the patient's left nasolabial fold is absent and the left corner of the mouth droops significantly, but the left eyebrow elevates and the left eye closes firmly. Which NIHSS score applies?
- 0
- 1
- 2 (Correct answer)
- 3
Correct answer: 2
Significant lower facial droop with intact upper facial function describes partial (central) paralysis—NIHSS Facial Palsy score 2.
Question 5: Which of the following patients would most likely receive an NIHSS Facial Palsy score of 0?
- A patient with Bell's palsy presenting 2 weeks ago with complete recovery (Correct answer)
- A patient with a left MCA stroke and a slight right nasolabial fold flattening
- A patient with a brainstem stroke and complete bilateral facial paralysis
- A patient with a pontine lesion and inability to close the right eye
Correct answer: A patient with Bell's palsy presenting 2 weeks ago with complete recovery
A patient with fully resolved Bell's palsy who now has normal symmetric facial movement scores 0 on the current examination.
Question 6: Facial Palsy is item number ___ on the NIHSS, and it contributes a maximum of ___ points to the total score.
- Item 4; maximum 3 points (Correct answer)
- Item 5; maximum 4 points
- Item 3; maximum 2 points
- Item 6; maximum 3 points
Correct answer: Item 4; maximum 3 points
Facial Palsy is NIHSS item 4 and is scored 0–3, contributing a maximum of 3 points to the total NIHSS score.
Question 7: A patient with right MCA stroke is sedated and unresponsive. The examiner applies a sternal rub. The right side of the face grimaces briskly; the left side shows no movement. What NIHSS Facial Palsy score should be recorded?
- 0 – symmetric at baseline rest
- 1 – minor asymmetry on stimulation
- 2 – partial palsy; lower face asymmetric
- 3 – complete palsy; no movement on one side (Correct answer)
Correct answer: 3 – complete palsy; no movement on one side
Absent facial movement on one side in response to noxious stimulation indicates complete paralysis, scored 3.
NIHSS Facial Palsy 5
A nurse re-evaluates a stroke patient 6 hours after admission and notes the patient can raise both eyebrows but cannot move the left lower face at all.
She scores Facial Palsy as 2.
Is this correct?